NCQA-BBQ: It is to laugh

So, got this in email the other day:

"A new ratings system created by the National Committee for Quality Assurance (NCQA) provides consumers with a more accurate picture of how health insurance plans perform in key quality areas."

That's (mildly) interesting, but what were those "key" areas?

Oh:

"[C]linical quality, member satisfaction and NCQA Accreditation Survey" [emphasis added]

Are you kidding? One third of the metric is itself?

How does that work?

More importantly, though, is the self-delusion that consumers actually care about these kinds of things:

"Oh sure, Anthem has a terrific rate, $100 a month cheaper than Humana, but Humana ranks 3 spots higher on NCQA, so I'll go with them."

Said no one, ever.

It's similar to the experts who claim that folks inadvertently "leave money on the table" by not choosing a health insurance plan that offers cost-sharing in addition to premium subsidies. There's a reason, and it's not ignorance of the program.

It's human nature.

Wellness vs Privacy

Are you kidding me?

"Houston required employees to tell an online wellness company about their disease history, drug and seat belt use, blood pressure and other delicate information."

And the best part (for certain values of "best")?

"The company ... could pass the data to "third party vendors"

Oh goody!

Of course, employees could opt out, no problem.

Wait, what?

"[B]ut only if they paid an extra $300 a year for medical coverage."

So the vendor sells employee info, and employees that take a pass get dinged for $300?

Exit question: how much cash does each employee get for the re-selling of their private health info? Oh, they "save" $300 on insurance?

Seems legit.

68,000 and Counting

The miracle and wonderment of ICD-10 has been blogged on before, but now that day is upon us. At

midnight September 30 someone will flip a switch and ICD-9 coding will be no more and will be replaced by ICD-10.

Sounds so simple, doesn't it?

The updated system has about 68,000 codes, essentially an expanded dictionary to capture more of the details from a patient's chart.

How precise? Get nipped feeding a bird, and the codes can distinguish if it was a goose or a parrot. Have a bike accident with one of those horse-drawn tourist carriages? Yep, there's a code for that, too. - Post Bulletin

What color was the goose?

The government says this will make life better and improve quality of care.

When has anything turned out the way the government promised?



#ICD-10  #healthcare  #medicalinsuranceclaims

ICYMI: Kaiser Foundation Lies

The lying liars at the Kaiser Family Foundation want us to believe that:

"Since 2008, average family premiums have climbed a total of $4,865."

And this, while they "calculate that deductibles have risen more than six times faster than workers’ earnings since 2010."

Now, how do we know that they're telling fibs?

Well, who ya gonna believe, KFF or:

Kudos to us!

So, just received word that we've been selected as one of the best Men's Health blogs by Healthline (a comprehensive health information portal). Healthline's editors chose us "based on quality, frequency of updates and contribution to the community." The full list is available here.

We're honored to be #2 (out of 10 selected). Thanks, Healthline!

Yes, The New York Obamacare Co-op Pissed Away $340 Million

I posed a question for this answer to IB readers back a year ago. In fact, Mike and I both wrote posts about New Republic dating back to January of 2013. So what's happening now?

New Republic is the health insurance cooperative in New York. They boast having the largest enrollment of any of the government funded co-ops with over 150,000 members. However, it is being shut down by the State of New York and CMS. This should not come as a surprise. Especially knowing that in 2014 they had the lowest rates (by far) in several areas across the state and weren't allowed the premium increases they requested by the New York insurance regulators for 2015. They hemorrhaged $77.5 million dollars in 2014 and another $57.2 million was lost over the first six months of 2015. Ouch.

A little history is important. Before New Republic we had the Freelancers Union. They had their own insurance company - Freelancers Insurance Company (FIC) that was notorious for consumer complaints. Freelancers ended up terminating the entity when Obamacare became a reality. As FIC was winding down, the union was in the process of creating a new venture which they received $340 million in Obamacare grants to start up a health insurance co-op. Instead of associating it with Freelancers, union leadership created a new non-profit which became known as New Republic.

We've already seen other co-ops bite the dust so why should we care more about this one? One word:  relationships. The relationship concern here is between the Freelancers Union, New Republic, and the Obama administration. Freelancers was established in 2003 by Sara Horowitz. Ms. Horowitz is a longtime close friend of President Obama. Back when President Obama was in the Illinois state senate, he and Ms. Horowitz worked together to launch the George Soros-funded liberal think tank Demos. It should also be known that Ms. Horowitz is a Deputy Chair of the Federal Reserve of New York and has been reported to have close ties with U.S. Senator Kirsten Gillibrand.

Having friends in high places has netted Horowitz and the Freelancers Union a nice chunk of change. Some may suggest that these co-ops were funded in the same scope as Solyndra. In this case it is not even close. This goes well beyond the scope of Solyndra. This didn't hedge on success of a new technology or product. This allowed our federal government to give huge amounts of money that went directly to lining the pockets of those who aligned and aided a political interest.

As we untangle the web we can see one thing - it's good to be one of Obama's political cronies. And for 150,000 people in New York, sorry but, if you like your plan you definitely aren't keeping it.

#LIAM2015: What's it's *Really* All About

So, two decades ago, George bought a 20 year level term policy. Two months ago, the initial rate guarantee period ran out, and his premium shot up dramatically (as they are wont to do). A month or so ago, we met to discuss options, at which time he decided to "let it ride," at least for a while.

Three weeks ago, he died on the operating table from a stroke.

Yesterday, I met with his widow to finalize the death claim paperwork (it took several weeks for the official death certificates to be processed).

And in another week or so, I will deliver a check for $250,000 (plus interest) to her.

There is really nothing remarkable about this process; after all, everything went as it should (save for the delay on the death certificates, which was out of our control).

And yet...

And yet, there is everything remarkable about it: over the years, George paid in several thousand dollars in premiums, a mere fraction of what his widow will receive. When we met last month, he was considering applying for a new policy with lower premiums and, of course, a lower face amount.

But he let it ride.

And in a week or so, I will be the only person in his widow's life who will be giving her money.

It just doesn't get any better than that.

Thursday Linkage

■ FoIB Jeff M alerts us that Medicaid Reform has at long last arrived in the Tar Heel State:

"After several major revisions, Medicaid reform that had delayed budget approvals during recent years passed the General Assembly ... This new system will focus on keeping people healthy and delivering care where it makes the most sense for patients"

Time will tell, of course, whether these new metrics ultimately make a difference.

■ And from FoIB Holly R, we learn that health insurance deductibles are outpacing wage increases:

"Kaiser ... calculates that deductibles have risen more than six times faster than workers’ earnings since 2010."

This is, of course, typical right-wing propaganda, since we know that "if you like your plan, you can keep your plan" including your preferred deductible.

Shame on the Kaiser Family Foundation.

■ From the "Your Tax Dollars @ Work" Department:

"Nearly half a million ObamaCare enrollees were able to claim more than $235 million in excess subsidies that they will never have to pay back" [emphasis added]

The article includes a real contender for "Best Line of 2015," as well:

"[T]hanks to a quirk in the law that leaves the program vulnerable to potentially billions in excess subsidy payments."

Gee, maybe they should have read it before they passed it.

Naah, that's just crazy talk.

From the "Oy, Don't Give 'em Ideas" Dept

FoIB Dr Val tips us to this groundbreaking new plan design:

"With our Infinity Plan, you’ll see only a very small amount deducted from each paycheck, and then all you’ll have to do is pay as you go for whatever health care you may need”

Best of all? No confusing paperwork or networks. Woot Woot!

Health Wonk Review: Beautiful Autumn edition

Louise Norris celebrates the official beginning of Fall with a jam-packed (SWIDT?) collection of interesting, provocative posts. From Ethics to IT, you're sure to find something to pique your interest.

Free Market Movement

Days after Turing Founder Martin Shkreli defended his  position for raising the price of Daraprim to $750 the company is now make more changes.

Early this week, Turing’s decision to raise the price of Daraprim from $13.50 a tablet to $750 was the subject of a New York Times story. The drug, which is generically known as pyrimethamine and was acquired by the company acquired in August, is used to treat a serious parasitic infection called toxoplasmosis, which can be life-threatening for those with compromised immune systems. 

Shkreli said the new price will allow the company to break even or make a “small profit” on the drug. - Fortune

Government intervention not required.


#Daraprim  #PrescriptionDrugs

Warm Fuzzies & 404Care.gov Security Theatre

Imma just leave this here:

"Centers for Medicare & Medicaid Services (CMS) was using only weak security measures to protect a HealthCare.gov performance dashboard data warehouse ... including income and Social Security information ... not encrypting MIDAS users' sessions"

Your tax dollars hard at work. And your Social Security numbers made freely available.

Sleep tight!

I don't get it [Updated & Bumped]

[Scroll down for Update with important observation]

A man has been convicted of murdering his wife of 12 years "to benefit from her $4.7 million in life insurance policies, which she didn't know existed." [emphasis added]

Hunh?

I've only been in this industry a measly 31+ years, so maybe I'm missing something, but how does one amass almost $5 million in life insurance and not even know about it?

Years ago, Petersen International Underwriters would issue policies on divorced spouses to cover alimony and/or child support obligations; supposedly, this could be done without the insured's knowledge. I never understood how this would work, but it's a moot point now since they apparently no longer offer that coverage.

Life insurance applications require that the proposed insured sign multiple times, and depending on the face amount, undergo medical underwriting (exams, financial interviews, etc). I just don't see how the perpetrator was able to obtain any such coverage, let alone almost 5 million dollars worth of it.

Someone care to clue me in?

UPDATE: FoIB Jeff M asks this rather crucial question (that the MSM didn't/won't):

"Since the lady's dead, how would anyone know whether she knew the insurance policies existed?"

Did the prosecution avail itself of the court's Ouija board?

Drug Pricing Problematic

As the cost of prescription drugs rise the impact on total health care expenditures is significant.

Consider the cost of Daraprim.

New York-based Turing bought the drug called Daraprim for $55 million this summer. It is used to treat toxoplasmosis, a parasitic infection that can be severe in patients with compromised immune systems, such as HIV, and for pregnant women. Earlier this month, the head of the Infectious Diseases Society of America and the HIV Medicine Association condemned the price increase from $13.50 a pill to $750, noting that the average cost per year for a patient weighing more than 132 pounds would be $634,500. - Washington Post

Drugs that have proven effective in treating specific conditions can be pricey, especially where there is a limited distribution population.

HIV patients comprise a relatively small number in the general population. As patients that are HIV positive have longer lifespans the total cost of care can be significant.

Never letting a crisis go to waste, it doesn't take long for politicians to step in and "fix" the problem.

Hillary Clinton can't keep track of her emails and claims to be electronically challenged yet it didn't take long for her to Tweet this comment.

Price gouging like this in the specialty drug market is outrageous. Tomorrow I'll lay out a plan to take it on.

I thought Obamacare and Medicare Part D were supposed to make healthcare more affordable.

Doesn't seem to be working so well.


#PrescriptionDrugs

O'Care By The Numbers

So, got the December renewal for one of my "grandmothered" small group plans, which indicated a hefty 17+% rate hike.

And that was the good news!

Here's why:

This group of just under a dozen employees (plus various dependents) is pretty generic: $30 doc visit co-pays, a prescription card benefit, $2500 per person deductible (max $5000 per family). The Maximum Out-of-Pocket (MOOP) is $3500 per person ($7000 per family). The group's renewal rate is about $7500 per month.

Or, they could choose to "upgrade" to a fully ACA-compliant plan for a ... might want to sit down for this ... 93% rate hike (to $12,000 per month). This included the privilege of upping the family MOOP from $7,000 to $8,500.

Yeah, I didn't get it, either.

Still, we decided that it was worth shopping around to see if we could do better. At the outset, I warned my client that he shouldn't get his hopes up too high, since all the plans we'd be looking at have to be ACA-compliant.

And I was not disappointed. To their credit, the quotes came in pretty quickly; I tried to pick out the plans that most closely resembled the current design:

Company A offered a $2,000/person deductible plan, co-pays and rx, with a $12,000 family MOOP for $12,700/month

Company M's plan had a $5,000/person deductible, co-pays and rx, with 1 $12,700 family MOOP, for the bargain price of $12,300/month

Company I was the best "deal" of the lot; its plan featured a $2,000 deductible, co-pays and rx card, and a $12,700 family MOOP for only $10,400/month

Finally, Company U had a $3,000 deductible, co-pays and rx, with a $12,500 family MOOP for a bit over $11,000/month

So you can see why this employer, at least, was singularly unimpressed.

The big question is how much longer we can hold onto his existing plan.

Time will tell.

In local news: Hospital's Medicare funding at risk

Co-blogger Bob V alerts us to this disturbing news:

"Miami Valley Hospital is in jeopardy of losing Medicare funding after an investigation found nursing staff failed to respond to a patient’s heart monitor alarm and deployed malfunctioning equipment that delayed the patient’s treatment during cardiac arrest."

The patient, who was emaciated and had a fairly extensive medical history, died, and CMS is up in arms:

"[T]he hospital “failed to evaluate nursing care related to the circumstances ... had the potential to affect all patients receiving care in the hospital.”

Miami Valley (MVH) is the flagship of an extensive local network of providers; it's unclear how this might affect other facilities in that network. The hospital's bureauweenies claim that they've undertaken steps to address the problems, and are now waiting on CMS for the verdict.

And there's this: it's not clear how losing MC funding would also affect MediGap and Medicare Advantage plans. After all, they "follow" MC, so if expenses are denied under MC, one would think that supplemental plans would follow suit.

Oy.

Dubious 105 Tricks

Recently, a colleague asked me if I'd heard of the "Classic 105" plan. I admitted that I had not, and he began to describe it to me.

I burst out laughing.

This scheme had it all: Section 105, Dead Peasant insurance, dubious policy loans, the works.

So, he sent me some links to get me started, and I began my own search to augment those. What I found was, um, intriguing.

Here's the concept in a nutshell (emphasis on "nut"):

"My employer claims that signing up for this "105 Classic Plan" will allow me to make %30+ of my income tax free. The jist [sic] of it is that they will take $560 per (bi-weekly) pay period out of my check, somehow "make it tax free" and refund most of it back through some vague "loan" that I apparently don't have to pay back.

This will reduce my income taxes pretty massively... but not only that, the company making my money untaxable claims it will pay 75% of all my out of pocket medical expenses up to $12,000."

So, there's the Section 105 part, but how, exactly, does this 75% reduction actually work?

For that, we go to the fine folks at Hill, Chesson & Woody, a company that also administers various benefit plans, and which did its own "due diligence" regarding the Classic 105 design.

They were able to dig through the chaff, and determine that:

"To make up for the significant reduction in the employees’ take-home pay, the employees are given a loan by the TPA each payroll period in an amount close or equal to the salary reduction amount. No taxes are paid on this amount because it is considered a loan, however there is no evidence that the loan is ever intended to be repaid.The loan is secured by a life insurance policy on the employee, held by the TPA."

And there's the "Dead Peasant" component.

Here's why my alarm bells went off: both sections are illegal (the former due to The ObamaTax, the latter through other legislative action).

Keeping kosher means never mixing milk and meat, nor ingesting pork products of any kind. I've always wondered, then, if a bacon cheeseburger would pass muster because the two negatives would cancel each other out [ed: this is a joke]. Perhaps the folks behind the Classic 105 scheme figured on the same calculation.

In the event, I turned to my own experts for their opinions.

My gurus of all things FSA/HRA/HSA, the folks at FlexBank, assured me (once again) that Section 105 reimbursement plans (where employers essentially pay for their employees' individual medical plans) have been verboten for several years now, no matter how pretty the packaging.

The tax implications posed another set of challenges, especially regarding the "Dead Peasant" nature of the life insurance portion. So, I once again turned to my favorite tax-blogger, Joe Kristan (who's helped us with this particular subject before). He notes:

"Without seeing all the plan documents, I will only point out the most obvious reasons this won’t work:
► Debt forgiveness is a taxable event.
► Life insurance is a taxable benefit unless it fits the narrow exclusion for $50,000 in term life.
►It is almost certainly an “overall scheme” that is treated as a non-compliant group plan under ACA guidance (FAQs about Affordable Care Act Implementation (Part XXII)), triggering the $100 per employee daily penalty."

Seems pretty dispositive to me.

But there's another piece that was niggling at me, and I finally figured out what that might be: what life insurance carrier is going to issue such a policy? There are only two possibilities: a group term plan, or individual policies.

I reached out to the field rep for one of our group non-medical carriers, and asked if this was even doable in that configuration. The short answer: no, because it would require that each participant execute an Absolute Assignment form, and he wasn't aware of any carrier that would accept one. Does that mean that no such carrier exists? No, but good luck finding one.

I also spoke with the underwriter at our primary life insurance carrier, who confirmed that absent insurable interest at time of issue, she wouldn't sign off on such a plan. Of course, there'd be nothing stopping the insured from changing the beneficiary post-issue, but that seems likely to provoke some major questions from the participants.

The bottom line is that this particular program fails to pass the smell test. I understand that there are agents still pushing it, perhaps out of ignorance, perhaps for other motives. Regardless, this isn't a plan I'd ever recommend to my clients.

Which is a shame, really: remember, the first ‘A’ in “ACA” is supposed to stand for "Affordable." So why would Uncle Sugar cut off a simple, cost-effective method for reducing the net cost of individual plans (by axing 105's)? I think the real shame here is that folks have to come up with these complicated, questionable schemes in order to make that "Affordable" a reality.
section 105, hra, classic 105, dead peasant, tpa

Leaving dollars on the table

Most folks are likely aware of the premium credits ("subsidies") available to folks who qualify due to their incomes. These are essentially health insurance "gift cards" redeemable at the insurer of one's choice (well, for certain values of "choice:" plans must be bought on-Exchange to be eligible).

But there's another piece of that subsidy that has apparently gone unnoticed - and underutilized:

"More than 2 million public exchange enrollees eligible for cost-sharing reductions are not receiving the subsides because they selected a non-qualifying plan"

Basically, certain plan designs not only qualify for premium subsidies, but for actual health care expenses to be reimbursed, as well:

"Washington-based Avalere found ... 2.2 million consumers potentially paying more out of pocket than the Affordable Care Act intended because they selected a plan that does not qualify"

And why is that? Well, the consultants blame consumers for looking primarily (perhaps exclusively) at the premiums side of the equation, giving short shrift to the cost-sharing portion.

This is what is known as "bullcrap."

Folks who qualify for premium subsidies by definition are focused on the immediate out-of-pocket cost of the plan itself. If they're willing to potentially eat a $13,000 out-of-pocket for something that may happen (but likely won't), then is it really a surprise that their focus is on the immediate hit to their wallet?

Yeah, didn't think so.

Thursday Morning LinkFest

■ Your tax $'s @ work:

"The public employees responsible for overseeing $600 million in contracts to build HealthCare.gov were inadequately trained, kept sloppy records, and failed to identify delays and problems that contributed to millions in cost overruns."

But other than that, Mrs Lincoln....

But sure, the 404Care.gov site's totally under control now.

■ Meanwhile, those CO-OPs are going great guns.

Wait, what?

"A state court in Louisiana has issued an order ... to put Louisiana Health Cooperative in rehabilitation."

Let's see: they started with $56 million in taxpayer "loans" (aka gifts) which they promptly burned right through; now, it doesn't even meet the minimum surplus requirements necessary to retain accreditation. Never fear, though, the state still has access to another $9 million to throw at this raging success.

■ Back in May, we reported that Assurant Employee Benefits (which markets group term, dental and disability plans) would likely be okay despite its parent company hitting the skids and selling off assets.

Turns out, the company's been snatched up by an erstwhile competitor, Sun Life of Canada for just shy of $1 billion. So what's in store?

"[W]hat they talked about most often was Assurant's group dental business."

This is actually a pretty hot market right now, as is vision (which they also sell). I'm fortunate to know a few Assurant Benefits folks, and they're all top-notch. Fingers crossed that this is a positive development.

■ In potentially Not-So-Great news. long-time admin Ceridian is bailing on the COBRA-compliance marketplace. In email from Medical Mutual of Ohio:

"COBRA vendor, Ceridian, recently sent communications to brokers saying that Ceridian is leaving the benefits continuation services (BCS) business and all Ceridian customers will transfer to WageWorks."

The transition is expected to go smoothly (and maybe this one will). Click here for more details.

Funding Long Term Care: Voila, #5!

Traditionally, there have been 4 basic ways that folks pay for long term care:

► Family/friends
► Savings/investments (self-funding)
► Medicaid
► Long Term Care insurance

Now, it seems, there's a fifth option: life insurance.

One of HIPAA's lesser-known sections deals with viaticals. This is where one sells a life insurance policy for immediate cash. Most folks think of these as a cash cow for folks with (for example) AIDS, but there's another "twist" available: long term care funding.

During my most recent Long Term Care insurance "refresher" course, the instructor mentioned that a company called Life Care Funding has developed a program to use existing life insurance plans to pay for long term care, by essentially viaticating one to pay for the other. I was intrigued, and filed it away for future investigation.

And then, several days ago I received an email about this very company. So I immediately reached out to see about an interview, and head honcho Chris Orestis kindly obliged:

■ InsureBlog: I'm a bit unclear on the tax issues. This is viaticating a policy; it appears that cash goes into trust for LTC disbursement. How is the disbursement not taxable?

Chris Orestis: In many cases, the proceeds received from converting a life insurance policy insuring the life of a chronically or terminally ill individual into a Long Term Care Benefit Plan will not be subject to U.S. federal income tax.  As a general rule, proceeds from the sale of a life insurance policy are subject to U.S. federal income tax; however, the Internal Revenue Code provides special exemptions for sales of life insurance policies insuring the lives of individuals who are terminally ill or chronically ill.  In the case of a terminally ill insured, the proceeds from the sale of the policy will not be subject to U.S. federal income tax regardless of how the proceeds are used.  And, if the insured is chronically ill, the proceeds will not be subject to U.S. federal income tax so long as they are used solely to pay for qualified long-term care services.

[ed: Mr O didn't specify, and the LCF website doesn't note it, but one presumes that he's referring to Code Section 101(g)(2)(A), which basically exempts these types of sales from taxation if they're for the benefit of terminally or chronically ill individuals.]

In addition, the current estate and gift tax exclusion is more than $5 million. Therefore, unless the insured has an estate in excess of the exemption, any residual amount of the Long Term Care Benefit which remains in the account when the insured dies may pass to the account beneficiary(-ies) tax free.  If the policy owner and insured are not the same person then, in the case of a chronically ill insured who passes while funds remain in the Long Term Care Benefit Account, the policy owner will be required to pay U.S. federal income tax on any residual amounts remaining in the account.

■ I presume that the funds in trust are invested in some way? How is the growth not taxable?

The funds are not invested.
 
■ Okay, then why not?

The reason is that the duration of the Long Term Care Benefit Accounts is typically too short to warrant the costs of investing funds. The accounts typically last 2-3 years and the funds are used to pay for long term care related expenses.

■ What is the mechanism for triggering/paying claims? Is there a waiting period?

The Long Term Care Benefit Plans are used to fund immediate need for senior care services. Typically funds are being sent to care providers the same day the account is funded. To qualify for enrollment, care must be funded by the account within 90 days or less of being opened.

■ It seems like PHI would be involved in that process: how is this protected?

There is a simplified underwriting process that primarily involves reviewing medical records and phone interviews. HIPAA releases must be signed before underwriting begins and HIPAA compliant protocols are followed throughout the underwriting process.

■ Would it be correct to say that this is something like a reverse mortgage but for long term care, not housing?

It is an understandable analogy, but this is the sale of the policy and there are no costs for the policy owner and nothing is paid back, whereas a reverse mortgage is a loan that involves fees and the money is secured against the house and must be paid back with interest.

■ If the insured pays no fees, who does? Someone gets paid for this: who and how?

Life Care Funding covers all fees and expenses and makes money because we own the policies and collect the death benefit when the insured dies. Our target is a 10% profit range.

■ What role is there for the agent (if any)?

Licensed life insurance agents that hold a life settlement broker’s license (in states that require one) can offer this program and receive commissions as compensation.

Whew!

Thanks, Chris, for your time and your thoughtful answers.

I'll conclude with a few thoughts of my own:

First, I really like this kind of outside-the-box thinking, and applaud the LCF folks for discovering a creative addition to the more commonly known funding sources. That being said, I see this program having limited application. In no particular order:

1 - It's not partnership-compliant.

2 - It uses up life insurance proceeds that will no longer be available for estate preservation or legacy purposes (although, as noted, it does allow for final expense reimbursement)

3 - It's the opposite of insurance (more dollars in than out)

On the other hand, it seems like a viable alternative (or supplement) for folks with insurability issues, and/or who have excess life insurance coverage.

[Special IB thanks to Brittany Thomas for arranging the interview]

ICYMI: Health Wonk Review Updated

Just got word that last week's outstanding edition just got even better with the addition of  uber-wonk Roy Poses' terrific post on the revolving door between U.S. government and the country’s growing corporate health sector.

Good stuff.

Unexpected!

"10 states with the least competitive health insurance markets"

Exit question: What do all 10 (now) have in common?

Yup.

L'Shannah Tova 5776

Tonight marks the beginning of what we call The High Holy Days (aka High Holidays). It is a time for rejoicing, and reflecting. It's about what's in the rear-view mirror, but also - and more importantly - about the road ahead.

We'll dip apples in honey and blow the shofar, cast bread on running waters and fast for a day. But mostly, we'll spend time in solemn contemplation and community worship. It is a season overflowing with deep emotions: joy and sadness drive each other, and drive us.

May your 5776 be one of peace, joy, love, and health.

Another 1,000 Words on O'Care

Way to bend that cost curve!

Which Form 1095 Will Jim Receive?

Jim worked for a company with less than 50 employees at the start of 2015. He received insurance benefits from this firm's fully insured contract through Aetna. He was let go in May and had to purchase a plan through healthcare.gov or faced paying a tax. Then in August he was offered a position with a fortune 500 company that has thousands of employees and an employer sponsored insurance package. He's now preparing for the upcoming tax season and is confused about which forms he will be receiving to prove he had insurance. Will Jim receive:

A. form 1095-A
B. form 1095-B
C. form 1095-C
D. All of the above

If you chose D you are correct!

Form 1095-A is the form he will receive from the marketplace for being insured through the exchange from May to August. Form 1095-B will come from Aetna during his first job based insurance that covered him from January to May. He will also receive form 1095-C from his large employer who he ended the year working with. This will confirm his coverage from August through the end of December.

You see how easy this is?

Uber vs Insurance: Updated

It's been a while since we looked at how insurers are dealing with their insureds who also drive for Uber. As we noted this past Spring, private passenger auto polices don't typically cover business-related risks, and full-blown business auto coverage can get (as the kids say) spendy.

Believe it or not, though, Erie Insurance has addressed this seeming paradox head-on (so to speak) and come up with an effective - and unique - solution:

"The new car insurance coverage solves a longstanding problem for drivers in the ridesharing economy by eliminating confusion over what's covered and when. With ERIE's new coverage, the driver has insurance coverage during every part of the trip—before, during and after the hired ride."

There are really several components to the Uber transaction: the driver signs up to be a driver (but hasn't yet agreed to any particular fare). So, no problem because it's all just theoretical at this point. But then he gets a "call." Assuming he agrees to take that fare, then he's entered into a contract, and the car is now a business. Ruh ro. At this point, and while the passenger is actually in the vehicle, it's business use and likely excluded.

Of course, once the fare's dropped off, our examplar is back to private use, no problem.

What Erie's done is streamline this so that their insured has coverage at all three stages. And just how do they accomplish this Herculean feat?

Watch and learn:



Meanwhile, Uber itself has its own insurance battle going on.

Health Wonk Review: The Selfie edition

Steve Anderson presents one of the very best Health Wonk Reviews I've ever seen. Pop on over (and don't forget your selfie-stick!).

A Tale of Two Presidents

It is the best of times. It is the worst of times. So which one is true?

Way back in March of 2015 the president had this to say as reported by The Crux

President Obama came under fire for a major Social Security cut he outlined in the White House’s 2015 budget proposal.
Obama’s proposed Social Security cut  came at a time when many American seniors were already suffering significant financial hardships.

The percentage of senior citizens between 75 and 84 years old who live in poverty recently doubled…

And many seniors were forced to deplete their savings during the last recession, making them increasingly reliant on Social Security income to survive…

On page 150, in black and white text, the White house said it intends to “eliminate [the] aggressive Social Security claiming strategies”  that some Americans are using to maximize their Social Security benefits.

In other words, Obama isn't pleased with people who UTILIZE the law to MAXIMIZE their benefits. For someone who mostly operates above the law, I find this approach to be incredible.

Even more revealing is what the president had to say on July 13, 2015.

When Social Security was signed into law, far too many seniors were living in poverty.

Medicare and Social Security are not in crisis, nor have they kept us from cutting our deficits by two-thirds since I took office. - White House

So which is it?

If Social Security is not in crisis, then why propose cuts to the program?

Of course this is the same president that once said "I do think that at some point you have earned enough money". Isn't this just a tad out of touch?

And if he cut the deficit by 2/3 since taking office why is the deficit figure $8 trillion more than in 2008?